Periodontal disease is a chronic bacterial infection that affects the gums and bone supporting the teeth. Periodontal disease can affect one tooth or many teeth. It begins when the bacteria in plaque (the sticky, colorless film that constantly forms on your teeth) causes the gums to become inflamed.

Gingivitis

Gingivitis is the mildest form of periodontal disease. It causes the gums to become red, swollen, and bleed easily. There is usually little or no discomfort at this stage. Gingivitis is often caused by inadequate oral hygiene. Gingivitis is reversible with professional treatment and good oral home care.

Periodontitis

Untreated gingivitis can advance to periodontitis. With time, plaque can spread and grow below the gum line. Toxins produced by the bacteria in plaque irritate the gums. The toxins stimulate a chronic inflammatory response in which the body in essence turns on itself, and the tissues and bone that support the teeth are broken down and destroyed. Gums separate from the teeth, forming pockets (spaces between the teeth and gums) that become infected. As the disease progresses, the pockets deepen and more gum tissue and bone are destroyed. Often, this destructive process has very mild symptoms. Eventually, teeth can become loose and may have to be removed.

There are many forms of periodontitis. The most common ones include the following.

Aggressive periodontitis occurs in patients who are otherwise clinically healthy. Common features include rapid attachment loss and bone destruction and familial aggregation.

Chronic periodontitis results in inflammation within the supporting tissues of the teeth, progressive attachment and bone loss. This is the most frequently occurring form of periodontitis and is characterized by pocket formation and/or recession of the gingiva. It is prevalent in adults, but can occur at any age. Progression of attachment loss usually occurs slowly, but periods of rapid progression can occur.

Periodontitis as a manifestation of systemic diseases often begins at a young age. Systemic conditions such as heart disease, respiratory disease, and diabetes are associated with this form of periodontitis.

Necrotizing periodontal disease is an infection characterized by necrosis of gingival tissues, periodontal ligament and alveolar bone. These lesions are most commonly observed in individuals with systemic conditions such as HIV infection, malnutrition and immunosuppression.

Plaque is a combination of bacteria and sticky bacterial products that forms on the teeth. Its source is the natural bacteria in the mouth, of which more than 300 different species have been identified. In small amounts and when newly formed, plaque is invisible and relatively harmless. But when left to accumulate, it increases in volume (in large amounts, plaque can be seen as a soft whitish deposit), and the proportion of bacteria in the plaque grows.

The role played by plaque in the development of gingivitis was demonstrated in the early 1960s. Dental researchers had people stop brushing their teeth and let the plaque in their mouths build up. Within two to three weeks, signs of inflammation appeared - redness, swelling, and an increased tendency to bleed - and when brushing resumed, the inflammation went away.

Symptoms of Periodontitis

You can and should check yourself for the warning signs of gum disease. However, you may have gum disease that has spread into the bone and not have any of the symptoms. Most people do not experience any pain due to gum disease and therefore it often goes unnoticed. It is important to have regular dental checkups, including a periodontal examination.

The warning signs of gum disease include:

bleeding gums during tooth brushing

red, swollen or tender gums

gums that have pulled away from the teeth

persistent bad breath

pus between the teeth and gums

loose or separating teeth

a change in the way your teeth fit together when you bite

a change in the fit of partial dentures

Contact Smile Shine Dental if you notice any of these symtoms, and we will diagnose if you have a periodontal disease.

Diagnosis

We will inspect the color and firmness of the gums and test the teeth for looseness. We will also check the way your teeth fit together when you bite. X-rays may be taken to evaluate the bone supporting the teeth.

A technique called periodontal probing is the cornerstone of testing for gum disease. In this procedure, a small measuring instrument is gently inserted between the tooth and gum to measure the depth of the pocket.

Treatment

In the event you have gum disease, we will begin your treatment based upon your particular stage. In the earlier stages of the disease, most of the treatment involves root planing and curettage (cleaning) under the gum margins. It involves the removal of plaque and inflamed soft tissue in the pockets around the tooth with an instrument called a curette. Its purpose is to remove the bacterial colonies and the mechanical and chemical irritants that cause inflammation in hopes that the disease can be eradicated. The goal is that the gum will reattach itself to the tooth or will shrink enough to eliminate the pocket. In most early cases, root planing, curettage, and proper daily plaque removal are all that are required for a satisfactory result.

In more advanced stages, the treatment may become more complex. If after removal of the deposits, fairly deep pockets remain, they can be eliminated by a minor surgical procedure called gingivectomy. This is done under local anesthesia, and a medicinal dressing is placed to cover the wound area for a week or so while it heals. A similar procedure, called gingivoplasty, is used to remove excessive gum tissue and to provide a new and healthier shape for the gums.

In some cases, flap procedures are performed. The gum tissue in an area is lifted away from the teeth, all the underlying inflamed tissue and calculus are removed, the bone may then be reconstructed to a proper shape and the gum is then replaced to proper position and sutured. Healing of these procedures takes from seven to 21 days and is usually uneventful, although not without some expected post-operative discomfort.

Antibiotics are sometimes prescribed to treat gum inflammation.

Prevention

The most effective nonprescription tool available is the toothbrush. Because a toothbrush's ability to remove plaque is markedly reduced by splayed or matted bristles, toothbrushes need to be replaced at the first sign of wear. Soft bristles are superior to hard for removing plaque, but the kind of brush you buy is less important than how well you use it. Several techniques have been developed for effective tooth brushing and it is advisable to be instructed in at least one by a dentist. Flossing daily and brushing after meals will reduce the risk of developing plaque. Regular dental check-ups are important as well.

Periodontal (gum) diseases, including gingivitis and periodontitis, are serious infections that, left untreated, can lead to tooth loss. The word periodontal literally means "around the tooth."